Title: Cerebral Encephalitis- A Rare CNS Complication of Scorpion Sting
Authors: Dr Babita Ghodke, Dr Atul S. Rai
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.18
Abstract
Objectives- Scorpion envenomation is an important public health hazard in tropical and subtropical region. Envenomation by scorpion can result in a wide range of clinical effects including cardiotoxicity, respiratory dysfunction and a rare but important complication affecting the central nervous system being stroke both ischaemic and haemorrhagic.
There are about 1500 scorpion species known to exist, of which 30 are of medical importance. In India, the Indian Red Scorpion (Mesobuthus tamulus) common in Western Maharashtra, Gujarat, Kerala, Andhra Pradesh, Tamil Nadu and Karnataka, is known to cause focal neurological presentations which include hemiparesis, haemorrhagic or thrombotic stroke with poor outcome.
Methods
Case Report- A 45‑year‑old male, non hypertensive, non diabetic from a rural area (Raigad district), was brought to MGM Medical College and Hospital by relatives with a history of scorpion sting on the proximal phalanx of second toe of the left foot.
The patient presented in the emergency room with throbbing pain at the site of sting, profuse sweating, and rapid breathing with Glasgow coma scale of 12/15. His vitals were unstable with a blood pressure of 180/100 mmHg and a heart rate of 56 beats/min. Complete haemogram, renal and liver function tests, serum electrolytes were within normal limits. CPK MB levels were not raised. Chest radiograph showed evidence of bilateral pulmonary edema. Patient was admitted in the intensive care unit and was managed as a critical case. After 3 days of admission, patient developed unexplained unconsciousness. CT brain showed no evidence of intracranial bleed and MRI brain was suggestive of focal encephalitis in frontal lobe. CSF examination was done which was within normal limits, thus indicating the probable cause of encephalitis to be scorpion envenomation.
Patient was treated with prazosin and other supportive measures. However, there was no clinical improvement and the patient expired.
